Research studies have shown that cigarette smoking can cause adverse outcomes during pregnancy, birth, and over the long-term for both babies and pregnant individuals. Smoking cessation strategies that incorporate abstinence-contingent financial incentives have proven the most successful, but in the past this strategy has been difficult to scale up for those unable to access clinic-based locations.
A new study, led by researchers and colleagues at the Vermont Center of Behavior and Health, published in JAMA Network OPEN found that using a smartphone app (DynamiCare Health Inc) that monitored smoking and delivered incentives to participants’ debit cards, showed promise in achieving similar results to clinic-based best practices with financial incentives.
The study included 90 pregnant individuals aged 18 years or older from across 33 states who were recruited between April 2019 and May 2020. Participants were randomized to receive either “Best Practices” (BP) treatment featuring brief counseling and a tobacco quit line referral or BP with a financial incentives (FI) intervention delivered via a smartphone app. Participants submitted videos of themselves conducting salivary tests remotely and received autogenerated notifications detailing test results and associated earnings. Incentives were delivered from study start to 12 weeks postpartum via a debit card using an escalating schedule with maximum earnings of $1,620.
Results showed that individuals assigned to BP with FI had nearly four-fold greater odds of smoking abstinence across antepartum and postpartum assessments compared with individuals receiving standard best practice care. These results are consistent with meta-analyses showing incentives are the most effective intervention for peripartum individuals and provides seminal experimental demonstration that the intervention can be delivered remotely as effectively as clinic-based settings. This paves the way to “expand the reach of this intervention to a broader swath of peripartum individuals, including those with socioeconomic disadvantage, rural residents, Indigenous individuals, and other racial and ethnic minority individuals.”